Alcohol mixed with energy drinks and aggressive behaviors in adolescents and young adults: A systematic review.

PURPOSE: Consuming alcohol mixed with energy drinks (AmED) is a high-risk drinking practice. This systematic review examines how AmED use contributes to aggression (physical and sexual), in what role(s) (perpetrator and/or victim), in adolescents and young adult drinkers (age 25 and younger). METHODS: Computer assisted search identified 844 studies conducted prior to March 2023; of them 17 met inclusion criteria. RESULTS: AmED use was significantly associated with aggressive behaviors. Between-subject studies suggests that AmED consumers have higher rates of perpetration (physical fights, bullying) and victimization compared to peers who only drink alcohol; however, within-subject studies of AmED users find no difference in physical aggression by drinking event (AmED vs. occasions where consumer drinks alcohol only). Similarly, AmED use was a risk factor for sexually aggressive behaviors (e.g., unwanted contact) and victimization. CONCLUSIONS: AmED use is a significant risk factor both victimization and perpetration of violent acts. Differences in within- versus between-study findings suggests that risk is associated with use of AmED, and not event level differences in drinking occasions among AmED users. Findings highlight the relative paucity of studies examining victimization and sexual violence and the need for future studies to incorporate more diverse samples and methodologies to better understand patterns of AmED use, perpetration, and victimization.

Experimental tasks of behavioral risk taking in alcohol administration studies: A systematic review.

Research on emerging adults shows this population exhibits the highest rates of alcohol use and engages in the riskiest of behaviors (Boyer, 2006; Fromme, Corbin, & Kruse, 2008). Among experimental paradigms, prior reviews have established an increase in behavioral risk taking while under the influence of alcohol (Moskowitz & Robinson, 1988; Martin et al., 2013; Weafer & Fillmore, 2016). Previous research highlighted the importance of alcohol dose on behavioral risk taking and the lack of agreement on which psychometric tools are most accurate in assessing behavioral risk taking (Beulow & Blaine, 2015; King, Toule, De Wit, & Holdstock, 2002). This systematic review of experimental paradigms assessing the effects of the dose of alcohol on various behavioral risk taking tasks suggest that higher alcohol doses (0.6 g/kg and above) produces the most robust increase in behavioral risk taking across tasks, compared to lower doses of alcohol (<0.6 g/kg). Results suggest the BART is the most sensitive behavioral risk task used to detect increases in risk taking in moderate/higher doses compared to lower doses of alcohol. This review also highlights the difficulty in measuring behavioral risk taking, as behavioral risk taking is a complex, multifaceted phenomenon that may involve multiple constructs and means to capture it. Future research is needed to standardize experimental administration protocols, to aid in advancing the field of alcohol administration experiments, and to determine the most accurate measurement of behavioral risk taking. PUBLIC HEALTH SIGNIFICANCE: Past experimental paradigms measuring behavioral risk taking under the influence of alcohol in emerging adults have used various alcohol administration paradigms, experimental protocols, and behavioral risk tasks. Key to examining behavioral risk taking via experimental paradigms should use at higher alcohol doses. Future interventions need to assess for levels of blood alcohol concentration when assessing for at-risk populations for alchol use disorders.

Brain activation to cannabis- and alcohol-related words in alcohol use disorder.

Cannabis abuse commonly co-occurs with alcohol use disorder (AUD). With increased acceptance and accessibility to cannabis in the US, it is imperative to understand the psychological and neural mechanisms of concurrent alcohol and cannabis use. We hypothesized that neural alcohol-cue conditioning may extent to other drug-related stimuli, such as cannabis, and underwrite the loss of control over reward-driven behavior. Task-activated fMRI examined the neural correlates of alcohol- and cannabis-related word cues in 21 abstinent AUD and 18 control subjects. Relative to controls, AUD showed behavioral attentional biases and frontal hypoactivation to both alcohol- and cannabis-related words. This cue-elicited prefrontal hypoactivation was related to higher lifetime alcohol consumption (pcorrected < 0.02) and modulated by past cannabis use histories (p ≦ 0.001). In particular, frontal hypoactivation to both alcohol and cannabis cues was pronounced in AUD without prior cannabis exposure. Overall, frontal control mechanisms in abstinent AUD were not sufficiently engaged to override automatic alcohol and cannabis-related intrusions, enhancing the risk for relapse and potentially for alcohol and cannabis co-use with the increased social acceptance and accessibility in the US.

Replication of factors related to blackout incidence in U.S. high school students: A brief report.

Alcohol-related blackouts are a common, yet serious consequence that can result from heavy alcohol intake. This study tested a model examining whether factors identified in related samples (i.e., adolescents residing in the U.K. and U.S. college students) predicted blackouts in community-dwelling U.S. high school youth. Participants from a Northeastern U.S. high school with prior alcohol use (Mage = 16.0 years; 48.2% male, 78.0% White) completed a paper-and-pencil assessment including measures of demographics, alcohol and other substance use, externalizing behaviors, and injunctive norms about risky drinking behaviors. Hierarchical logistic regression examined which factors identified for U.K. residing adolescents (Block 1) replicated in the U.S. sample, and whether factors identified in samples of U.S. college students added additional explained variance (Block 2). Blackouts were reported by 35.6% of students. Regression results indicated that two variables previously identified in adolescents, female gender (OR = 3.26) and increased alcohol use (OR = 1.27) were associated with blackouts. College student risk factors of drinking game (DG) participation and, to a lesser degree injunctive norms for passing out, emerged as additional risk factors (ORs = 2.85 and 1.32, respectively), with the final model explaining 39% of the variance in blackouts. This study advances our understanding of blackouts in younger drinkers and identifies the importance of addressing blackouts within the context of intervention programming that addresses cognitions and high risk drinking practices like DGs.

Bell Ringers: Factors Related to Concussive Events in Children Playing Tackle Football.

INTRODUCTION: Sports-related concussion is a significant pediatric health risk, given the number of children involved in sports and the vulnerability of developing brains. Although most research has focused on high school/college athletes, these findings may not be applicable to younger athletes. METHOD: A mixed-methods analysis examined concussion incidence and sequelae in a cohort of 8- to 13-year-old males (N = 31) playing youth football and their parents. Parents provided background information and completed mood/behavioral questionnaires, and each athlete completed a neuropsychological battery. RESULTS: Eight athletes (26%) had a history of concussion before assessment. Concussion risk was related to lack of medical evaluation in prior concussions, tackling exposure (in both offensive and defensive positions), and multisport participation. There were no cognitive or psychological differences based on concussion history. DISCUSSION: Findings identify factors that may contribute to concussion risk in children and show the need for further research in this understudied population.

Evaluating the Effectiveness of a Medical Amnesty Policy Change on College Students' Alcohol Consumption, Physiological Consequences, and Helping Behaviors.

OBJECTIVE: This study summarizes the association between medical amnesty policy (MAP) implementation and drinking behaviors at a 4-year university. METHOD: First-year students (N = 1,246; 50.8% male) were assessed in the academic year pre- (2009-2010, n = 571) and post-implementation (2010-2011, n = 675). A cohort-sequential design was used. Students were assessed at college entry and end-of-year. Self-report measures assessed recent alcohol use, physiological consequences, and helping behaviors specific to alcohol-related medical emergencies. RESULTS: MAP implementation did not increase drinking, overall consumption, or the incidence of physiological consequences. Modest increases in contacting residence life staff in the event of an emergency were also found. CONCLUSIONS: This study provides empirical support that MAP policies do not increase consumption or problems and may reduce barriers to seeking help in the event of an emergency. Additional research is needed to establish the effectiveness of MAPs as an environmental-level strategy to reduce harmful drinking on campus.

Heterogeneity of Pregamers by Consumption and Reinforcement Reasons: A Latent Profile Analysis.

BACKGROUND: Pregaming is a common, high-risk drinking activity among college students that has been largely unchangeable despite targeted intervention approaches. Therefore, identifying profiles of pregamers could enhance understanding of the risks associated with this practice and inform intervention development. METHODS: This study identified subtypes of pregamers in undergraduates (N = 911; 60% female, 42.9% White) attending 3 U.S. universities in 2012. Self-report data assessed recent alcohol use (overall, heavy, and pregaming), pregaming motives, and demographics. Alcohol-related consequences were assessed via the Young Adult Alcohol Consequences Questionnaire. RESULTS: Latent profile analysis using pregaming-specific indicators assessing motives (e.g., to avoid getting caught) and consumption (e.g., estimated pregaming blood alcohol concentration) yielded 5 unique profiles. Three profiles were characterized by pregaming on 50% or more of all drinking events that differed by pregaming consumption and motives: Instrumental (5.3%; heavy consumption, intoxication-driven motives), Global (16.0%; moderate consumption, indistinct motives), and Risk-averse (18.3%; moderate-to-heavy consumption, negatively reinforcing motives). Two profiles reported lower levels of pregaming: Occasional (32.4%; moderate consumption, indistinct motives) and Infrequent (28.0%; lowest pregaming involvement). Cross-profile differences were then examined for demographics, general drinking and pregaming-specific motives, and alcohol-related consequences. Profile comparisons indicated differences in overall alcohol consumption, ethnicity, gender, current living arrangements, Greek involvement, and a variety of alcohol-related consequences (ps < 0.01). CONCLUSIONS: Overall, pregaming is a very heterogeneous behavior among college students in that some students utilize this drinking practice as a means to mitigate risk and others use it to promote intoxication. Results suggest that distinguishing pregamers by consumption as well as motives can facilitate the development of more tailored intervention approaches for students who engage in this high-risk practice.

Perceived Access and Parental Monitoring as Moderators of Impulsivity and Marijuana Use Among Adolescents.

The social and political climate regarding marijuana use has been changing in the US over the past decade. Research suggests that many adolescents report relatively easy access to marijuana and perceptions that recreational use involves minimal harm despite a growing body of research implicating the deleterious effects of use on cognitive and psychological development. Not surprisingly, prevalence rates have been rising in recent years, making it important to identify risk and protective factors associated with adolescent marijuana use. We tested a 3-way interaction model designed to (a) examine the relationship between behavioral impulsivity and marijuana use in adolescents, and (b) evaluate the roles of perceived access and parental monitoring as moderators of this relationship. High school students (N = 498, M age  = 15.7, 53% female, 77% White) completed an anonymous self-report assessment examining substance use, perceived access, and psychosocial factors related to substance use (i.e., behavioral impulsivity and parental monitoring). Results indicated that higher levels of impulsivity, greater access, and reduced parental monitoring were related to marijuana use. Significant moderating effects were found for perceived access and parental monitoring, such that use was greater for adolescents who perceived that marijuana was easier to acquire and for those with lower levels of parental monitoring. Among individuals with greater levels of impulsivity, parental monitoring reduced the impact of perceived access. Overall, results highlight risk and protective factors related to adolescent marijuana use and indicate that parental monitoring can be an effective means for reducing consumption.

Age of Initiation and Internet Gaming Disorder: The Role of Self-Esteem.

The link between early initiation and problematic use has been observed for substance use disorders; however, this link has not been as clearly established for Internet gaming disorder (IGD). Available studies indicate that individuals who initiate Internet use at younger ages exhibit an increased risk for general Internet addiction. Prior research also suggests unique cognitive processes in online gaming, such that an individual's overall sense of self-worth can become contingent upon self-esteem derived from the gaming environment. The current research examines the mediational role of self-esteem variables in the relationship between age of initiation and IGD symptomatology. Data were analyzed from 1,044 adult participants (mean age = 30.90; standard deviation: 9.28; 35.0% female) recruited from Amazon Mechanical Turk who reported playing massively multiplayer online role-playing games. Age of gaming initiation is directly linked to IGD, as earlier age predicted overall IGD symptom severity (b = -0.10, 95% confidence interval [CI: -0.17, -0.03]), controlling for self-esteem factors. In addition, self-esteem factors emerged as mediators of the effect, where global self-esteem served as a protective factor (b = -0.05, 95% CI: [-0.07, -0.02]) and high gaming-contingent self-worth (GCSW; b = -0.10, 95% CI: [-0.15, -0.04]) was associated with more negative outcomes. Earlier age of gaming initiation is associated with IGD symptomatology. Although risks of screen time are often referred to in terms of physical consequences, the present study provides support regarding the inclusion of self-esteem factors in the link between early use and IGD.

Sex and Drugs and Starting School: Differences in Precollege Alcohol-Related Sexual Risk Taking by Gender and Recent Blackout Activity.

Research has demonstrated a link between alcohol use and multiple forms of risky sexual behavior, particularly among college-age individuals. Studies have also linked heavy alcohol use to other problems, such as impaired consciousness resulting from an alcohol-induced blackout, which may impact sexual decision making. However, research has rarely examined sexual risk taking (SRT) in relation to blackouts, nor has it examined this construct during the precollege transition (i.e., the interval of time between high school graduation and college matriculation). This study examined the intersection between alcohol-involved SRT, blackouts, and gender in a sample of precollege individuals with prior alcohol use (N = 229; 54% male, 63% White). Results indicated that, despite drinking less per occasion, women reporting recent blackouts were at increased risk for experiencing unwanted, unsafe, and regretted sexual behaviors compared to men with recent blackouts and their peers with no recent blackouts. Women with recent blackouts also reported differences in alcohol expectancies that may increase their risk for experiencing negative consequences while drinking, including higher social expectancies and lower negative expectancies of danger. Future directions for research and implications for precollege interventions are discussed.

Extreme Consumption Drinking Gaming and Prepartying Among High School Students.

Drinking games and prepartying (i.e., drinking before going to a social gathering/event) have emerged as high-risk drinking behaviors in high school students. The present study examines the current prepartying behaviors of high school students who report current participation in extreme consumption games (e.g., Chugging) with those who do not. High school students (N=182) reporting current drinking games participation completed anonymous surveys. Gamers who prepartied frequently (vs. those who did not) were approximately 1.5 times more likely to play extreme consumption games, even after controlling for demographics, typical consumption, and participation in other types of drinking games. Practitioners should target adolescents who participate in extreme consumption games, particularly those who participate in this high-risk activity as a form of prepartying.

Variability in Pregaming Typologies Across the Freshman Year: A Multi-wave Latent Transition Analysis.

BACKGROUND: Though research is rapidly expanding on pregaming and related risks, studies have not yet identified discrete subtypes of college pregamers or modeled how class membership changes across critical times like college entry. OBJECTIVES: Latent Transition Analysis (LTA) identified classes of pregaming behaviors in entering college students and described transitions in latent statuses across the freshman year. METHODS: Students with prior alcohol use (N = 711; 51.3% female; 63% White; Mage = 18) were surveyed at orientation and re-assessed at three follow-ups (Fall, Winter, and Spring). Items assessed overall drinking (past 30-day, number of binge episodes), pregaming (typical quantity, normativity relative to overall use, estimated pregaming BAC, drinks consumed post-pregaming event), and problems (overall and pregaming-specific). RESULTS: LTA modeling yielded three distinct classes of pregaming membership (Low, Medium and High) that varied as a function of both overall use and pregaming practices. Evaluation of changes over the year indicated the greatest movement occurred immediately upon college entry, with significantly less movement was seen across the remainder of the year. Cross-class comparisons across all four time points showed clear differences in alcohol-related problems (overall as well as pregaming-specific), with students in the High class reporting markedly higher levels of problems on all domains. CONCLUSIONS/IMPORTANCE: Overall, there appears to be considerable heterogeneity in pregaming behaviors, across both students and time that are directly related to differential levels of problems. Findings highlight the need to screen students early for risky drinking practices, including pregaming, and include pregaming-specific material in their campus screening and intervention programming.

Identification of hazardous drinking with the Young Adult Alcohol Consequences Questionnaire: Relative operating characteristics as a function of gender.

Heavy and problematic drinking is common on college campuses and is associated with myriad hazardous outcomes. The Young Adult Alcohol Consequences Questionnaire (YAACQ; Read et al., 2006) was developed to provide comprehensive and expedient assessment of negative consequences of young adult drinking and has been used in a number of research and clinical settings. To date, no empirically derived cutoffs for the YAACQ have been available for use in the identification of those drinkers at greatest risk. This was the objective of the present study. In a large (N = 1,311) and demographically heterogeneous multisite sample, we identified cutoff scores for the YAACQ, and the contrasted detection of hazardous drinking using these cutoffs with those recommended for the Alcohol Use Disorders Identification Test (AUDIT). We also examined whether cutoffs differed by gender. Results of receiver operating characteristic (ROC) analysis yielded cutoffs that delineate 3 levels (or zones) of hazardous drinking risk: low, moderate, and high. A cutoff of 8 differentiated those at low risk from those at moderate risk or greater, and a cutoff of 16 differentiated between moderate and high risk. These zones corresponded to other indices of risky drinking, including heavy episodic "binge" drinking, more frequent alcohol consumption, and engagement in alcohol risk behaviors. Scores differentiating low to moderate risk differed for men (8) and women (10), whereas the cutoff for high risk was the same (16) across the sexes. Findings suggest that the YAACQ can be used to reliably assess level of drinking risk among college students. Furthermore, these cut scores may be used to refer to interventions varying in intensity level, based on level of indicated alcohol risk. (PsycINFO Database Record

Identifying classes of conjoint alcohol and marijuana use in entering freshmen.

The current study identified classes of conjoint marijuana and alcohol use in entering college freshmen using latent profile analysis (N = 772; 53% male, 60% White; Mage = 18). Results yielded 4 distinct groups: Class 1 (moderate drinking with recent marijuana use: 22% of sample), Class 2 (moderate drinking with no recent marijuana use: 25%), Class 3 (light drinking with no recent marijuana use: 40%) and Class 4 (heavy drinking with recent marijuana use: 14%). Separate pairwise contrasts examined cross-class differences in demographics and drinking behaviors, comparing differences in drinking when current marijuana use was controlled (Class 1 vs. 4) and differences in marijuana use when drinking was held relatively constant (Class 1 vs. 2). Among moderate drinkers, recent marijuana users were more likely to drink more than intended, drink to get drunk, and had more problems (including higher rates of blackouts, physical injury, and DUI) relative to peers who refrained from marijuana. No cross-class differences were found for alcohol expectancies or behavioral motives. Findings from these analyses show the presence of distinct groups of conjoint users with different drinking behaviors and consequence profiles, and suggest that conjoint alcohol-marijuana use may be more problematic overall than single substance involvement and highlight the need for developing campus prevention and intervention programs that address the increased risk from polysubstance involvement.

Trouble brewing: pregaming among high school and incoming college students.

Pregaming (a.k.a., "prepartying," "pre-funking," or "predrinking") consists of drinking before going to a social function or gathering where alcohol may or may not be served. Existing research suggests that pregaming in high school and pre-college (i.e., the period between high school graduation and the start of college) is widespread. Moreover, pregaming prevalence appears to rapidly increase after students graduate from high school and transition into college. Thus, the purpose of this brief review is threefold: (a) to summarize the existing (albeit limited) research on pregaming among high school students and incoming college freshmen, (b) to present an overview of the risk factors that have been identified for participation in pregaming, and (c) to discuss the implications for practice that may be particularly relevant for school-employed/affiliated nurses as well as health practitioners who work in college settings.

Getting "game": pregaming changes during the first weeks of college.

OBJECTIVE: Many students pregame (ie, drink before drinking), but there are scant data evaluating changes following college entry. The authors examined pregaming across the fall quarter and identified predictors of change and initiation in college. PARTICIPANTS: Freshmen (N = 708; 53% female, 100% drinkers) were recruited during university orientation (baseline). METHODS: Self-report data were collected at baseline and end of fall quarter for 3 cohorts (the 2008-2010 academic years) and included demographics, alcohol use, problems, pregaming, personality, and expectancies. RESULTS: Pregaming increased from 61.7% (baseline) to 79.9% (follow-up), with students pregaming twice as often and attaining higher blood alcohol concentration at follow-up. Many (54%) baseline non-pregamers initiated by follow-up. Initiation was associated with increased overall drinking (including heavy episodic drinking), positive expectancies, and greater behavioral activation sensitivity. CONCLUSIONS: Pregaming rapidly escalates upon college entry and students who initiate in college may be at higher risk for alcohol-related problems. Campus prevention and intervention efforts should consider including pregaming in their prevention programming.

Pre-college pregaming: practices, risk factors, and relationship to other indices of problematic drinking during the transition from high school to college.

This study examined alcohol use and pregaming (i.e., drinking before going out) in the transition from high school to college and had 3 objectives: (1) evaluating pregaming prevalence and characteristics during this time, (2) determining whether it represents a unique risk for problematic drinking above-and-beyond traditional measures of consumption (i.e., quantity/frequency: QFI, and heavy episodic drinking: HED), and (3) identifying characteristics of individuals who pregame. Alcohol use and beliefs (i.e., self-reported quantity/frequency, pregaming practices, drinking game participation, alcohol-related problems, and expectancies) were assessed in entering freshmen (N = 1171) with prior alcohol use for the 3 months between high school and starting college. Results revealed that 65% of drinkers pregamed in the past, and most did so on fewer than 50% of their overall drinking occasions, consuming an average of 3 drinks in 27 min and most (87%) drank afterward. Hierarchical regression analyses indicated that pregaming frequency explained an additional 7.0% of variance in problematic alcohol use above-and-beyond overall drinking and demographic risk factors (e.g., gender, ethnicity, and Greek affiliation: R2 = .43 for overall model). Separate analyses indicated that demographics did not moderate the relationship between pregaming and problems. Regression analyses predicting pregaming frequency identified 7 characteristics associated with this outcome including demographics (gender, ethnicity, Greek affiliation), heavy drinking, drinking game frequency, and 2 scales of the Alcohol Expectancy Inventory (AEI: Attractive and Woozy). Findings implicate pregaming as a common practice during the transition to college, and highlight the need for additional studies examining pregaming changes across the freshman year.

Cigarette smoking in opioid-using patients presenting for hospital-based medical services.

Little is known about cigarette smoking among opioid users who are not in substance abuse treatment. The study examined cigarette smoking in out-of-treatment opioid users presenting at a hospital who participated in drug abuse research. Participants exhibited a high rate of smoking (92%) at baseline that remained unchanged at one year and were moderately nicotine-dependent. Nineteen percent preferred unfiltered cigarettes. Women were more likely to smoke menthol cigarettes; men were more likely to smoke unfiltered cigarettes. Caucasians tended to smoke more than other ethnicities and exhibited greater dependence. Out-of-treatment drug users continue to be at high risk for continued smoking.

The relationship between smoking history and current functioning in disabled community-living older adults.

PURPOSE: This study was conducted to determine characteristics associated with continued cigarette use in frail older adults and to examine how smoking history relates to current psychiatric, cognitive, and occupational functioning. METHODS: Archival records were gathered for 1,064 patients (69% women) who entered On Lok SeniorHealth Services between January 1996 and December 2000. Participants were interviewed on program entry and assessed for smoking history, depressive symptoms, affective disorders, cognitive functioning, alcohol use, and physical functioning (activities of daily living [ADLs] and instrumental ADLs). Cross-sectional analyses were conducted to examine functioning at enrollment relative to smoking history. RESULTS: Smoking history was related to age at program entry, with current smokers entering On Lok at an earlier age than former or never smokers. Current smokers were more likely to be male, to be of Caucasian or African American descent, to consume alcohol on a regular basis, and to be more independent on ADLs. Specifically, they were more independent on tasks related to their capacity to procure cigarettes or continue smoking, including shopping, using transportation, managing money, dressing themselves, and walking. Smoking history was related to depression, with symptoms lower for current and former smokers. CONCLUSIONS: Current smokers present for services at an earlier age and have higher levels of independence on ADLs instrumental to nicotine use. Data indicate characteristics associated with continued smoking and provide a foundation for targeting older individuals for cessation efforts.